A dermatologist finds fame among those for whom watching a pimple explode recalls the butterflies of a first kiss.

Photographs by Bobby Doherty

Two years ago, Dr. Sandra Lee, a dermatologist in Southern California, opened an Instagram account. She viewed it as an experiment; the surface of the internet was riddled with unseen pockets of desire, weird subterranean pressures, and she was inclined to prod it, gingerly, until she found out how deep they ran. Her first posts were fairly scattershot, many uploaded from unsurprising places like the golf course or poolside, but she also made the somewhat unusual professional decision to document her work on patients: slicing out cancers, lasering unwanted tattoos, mending earlobes torn by overzealous piercers. She became fascinated by why certain of her posts were shared more than others. Her face — with its immaculate skin, white-white teeth, little nose, and big eyes — naturally lent itself to selfies. However, many of her most popular posts were not about her, or her adorable kids, or her luxe vacations, but of the least glamorous aspects of her work: specifically, videos of her popping zits, cysts, and blackheads.

Lee, like most dermatologists, had never spent much time removing blackheads and whiteheads. In her opinion, performing “extractions” — a mundane, tedious, and nonessential procedure that was rarely covered by insurance — was labor better left for aestheticians. But a surprising number of her followers wrote that they fervently (if guiltily) enjoyed watching these simple dermal exorcisms. (“I love it so much 😫😫😫😫😫,” moaned a typical commenter.) Sensing an untapped audience, Lee began posting more videos of things popping from the skin, and her audience gradually grew. At first, she was wary of posting anything with too much “ick factor” — giant blackheads, say, or explosive cysts — for fear that she would upset the gentle people of the internet. However, her online fans didn’t seem to mind the ick; in fact, many of them relished it. Some fans reported that their mouths inexplicably watered when they saw a particularly juicy pop; others claimed that they found the videos so soothing that they used them as a sleep aid. Lee began setting videos to punnily titled music, like Duke Ellington’s “Just Squeeze Me (But Please Don’t Tease Me),” Mtume’s “Juicy Fruit,” and French Montana’s “Pop That.” She soundtracked one video to “People Are Strange” by the Doors. In the caption, she wrote, “People are strange. Strange because they like to watch this stuff. But I’ve realized you strange people are not alone — there are many of you!”

For videos longer than 15 seconds, Lee turned to YouTube, where she adopted the sobriquet “Dr. Pimple Popper.” Around the same time, she discovered that there was an entire sub-channel on Reddit dedicated to enthusiasts of popping, or, as they often call themselves, “popaholics.” Back then, the most famous producer of popping videos was a doctor in New Delhi named Vikram Yadav, who was known for removing impossibly huge blackheads from the noses of his aging, sun-scorched patients. The vast majority of popping videos, however, were still homemade. The popaholics, a fastidious bunch, complained that these videos were often unsanitary and poorly filmed. Lee realized that she was uniquely situated to provide these people with what they craved — she had a never-ending supply of pimples and the expertise to remove them cleanly.

One of the first films she posted to YouTube was of an octogenarian man with a swollen, misshapen nose (the result of a condition called rhinophyma). As Lee was inspecting him, she noted that his nose practically bristled with blackheads. She made him a proposition. If he allowed her to squeeze the blackheads from his nose and film it, she would perform the procedure for free. He agreed. To protect his anonymity, she referred to him only as “Mr. Wilson,” after his resemblance to Walter Matthau’s character in the film Dennis the Menace. That video — the first installment of what would become a series — shows her careful hands pressing a tiny metal loop, called an extractor, into the surface of the man’s nose. With each stroke of the extractor, a long tendril of whitish-gray sebum would burst forth. Sometimes multiple strings would appear simultaneously, like Parmesan cheese run through a rasp. “So gross but I can’t look away,” remarked one commenter. “I thought I was the only one who liked watching this!” wrote another. The video has since been viewed nearly 7 million times.

Lee’s office is located in the town of Upland, California, an hour east of Los Angeles, where the San Gabriel Mountains rise like divine warts from the arid expanses of chaparral and strip mall. At the latest count, her YouTube account has amassed 850,000 subscribers and more than 350 million views. She has been invited to pop blackheads and cysts on the syndicated daytime TV show The Doctors. And she has begun building a brand. Her office is strewn with merchandise emblazoned with the Dr. Pimple Popper logo, which she sells online: mugs, trucker hats, coffee cups, and, of course, extractors. The majority of her income still comes from conventional procedures — Botox, vein removal, skin-cancer surgery — but her YouTube channel could easily bring in hundreds of thousands of dollars this year.

One recent morning, Lee met with Mr. Wilson for another round of extractions. He arrived dressed in a pale-green safari shirt and a Members Only jacket. A taciturn man, he responded to most questions with grunts. He said that he had initially been reluctant to come to a skin doctor — it was his wife’s idea — but after the first procedure, he admitted that his nose did feel “cleaner.”

“You were actually the start of all this,” Lee remarked to him, as he lay supine on the operating chair. “I don’t know if that’s something you’re really proud of or not. But I am.” These days, some patients pay Lee for medical procedures and receive complimentary blackhead extractions if they let the extraction be filmed (and sign a release form). However, as a gesture of gratitude, Lee has never billed Mr. Wilson for any of her work treating his rhinophyma, ­popping-related or not.

Lee moved smoothly around her patient, making conversation and preparing the utensils of her craft. One of her many advantages over at-home poppers and aestheticians is that she is able to use anesthetic and surgical tools, which allow her to open pores that might otherwise remain blocked. Patients (and online viewers) universally praise her calm and friendly bedside manner, which she says she learned from her father, also a dermatologist, who was known for playing the ukulele for his patients. (“We have similar personalities,” her father noted. “But she has the advantage of being prettier.”)

Anywhere Lee thought she might have to use her scalpel, she would first inject a squirt of anesthetic, a mixture of lidocaine and epinephrine, which, in addition to numbing the area, constricted the flow of blood. In the world of popping videos, blood, the stuff of life, is regarded as a pollutant. Not only is it unsightly, but if a video is too bloody, someone on YouTube is likely to flag it as gore, and the video can be taken down. So Lee was meticulous about sopping up any blood with gauze, and when she spoke about blood on-camera, she tended to use the word ooze instead. “I really try to keep things nice and clean,” she remarked.

Lee began on the right side of Mr. Wilson’s nose, working her way down from the bridge to the bulb. Any easy blackheads she popped out with the extractor; the more deeply embedded ones received a delicate prick from the scalpel. Lee pressed hard and wiggled the extractor to pry loose the stubborn ones, leaving behind a series of U-shaped welts. When asked to rate the pain on a scale of one to ten, he judged it a five. After a while, Lee remarked that she had been pushing so hard that her hand had begun to cramp.

Lee’s assistant Kristie hovered over Mr. Wilson’s face with an iPhone, filming each step of the procedure. On the iPhone’s screen, the surface of his skin was transformed into an alien planet where sandworms periodically erupted forth from porous red earth. Visually, it was more impressive onscreen than in real life — larger, somehow. But the camera fails to capture the olfactory aspect of these extractions. Later, in private, Lee likened the odor of this one to “pungent cheese.”

When she was finished with the right side of his nose, Lee moved around to the left. There were noticeably fewer blackheads than during his first extraction, and fewer spectacular eruptions. Lee seemed to be growing slightly disappointed with the overall yield, until she pressed down on a rather inconspicuous-looking lump on the bridge of his nose and a several-inches-long ribbon of sebum tapewormed out. “It keeps going …” Lee said wonderingly. “See, you never know.” Once it had fully emerged, Lee lifted it up with the extractor and dangled it a moment in front of the camera, like a trophy fish.

“You had a big one there just now!” she said to her patient-star. “That one was worth all of it.”

According to popping aficionados, the sense of suspense and surprise is part of what lends the videos their hypnotic power; during a big pop, many viewers find themselves leaning in, holding their breath. “It’s like gambling,” Lee explained. “You never know when you’re going to hit a big one.”

In the late 1990s, a Belgian artist named Wim Delvoye released an experimental art film called Sybille II, in which he captured shots of whiteheads erupting in slow motion on 75-mm. film, framed in extreme close-up so that they resembled creatures in a Jacques Cousteau film. Delvoye intended it to function as a commentary about adolescence and purity, a puncturing of art’s lofty pretensions, but once it was uploaded (without his knowledge) on YouTube, commenters began dubbing it “probably the best zit video out there!!” and “pimple popping porn!!!!” Delvoye said recently that all of the film’s pimples had come from a single source: a young art student the other kids called “Old Pizza.” He met with the boy for multiple sessions, waiting a month after each “harvest” for his pimples to ripen again. Because the film stock was expensive, each session became a high-stakes game. “You didn’t know what was going to come out of the skin,” Delvoye said. “Sometimes you said, ‘Oh, well, let’s try this one, but it’s not going to be anything’ — and it came, and it came, and it came! We were constantly surprised.”

Delvoye has since lost track of Old Pizza and wasn’t sure whether the boy had even seen the final cut of the film. Likewise, almost none of Lee’s star patients have watched the videos of their extractions. Some simply don’t care; others find them a bit gross. Many of her patients are over the age of 70. (Blackheads tend to intensify with age, especially in sunny places like Upland.) Mr. Wilson said he had never bothered to watch his video. Neither had a kindly 86-year-old man known only as “Pops” (4,945,366 views), beloved by popaholics for his gentle personality and overactive sebaceous glands. A third patient, a sassy 79-year-old lady named Gerry, known to Lee’s fans for an enormous blackhead that was removed from her temple (6,927,531 views), seemed not to even understand what YouTube was. Gerry recounted the story of her extraction like this: “She asked me if she could take a picture, and she said it went on this … thing, and I got all these … things! And I said, ‘What?!’ ”

Gerry was cheerfully bemused by the whole experience; back in her day, she noted, people wanted to look at beautiful young people. “Why would they want to see an old lady with all these wrinkles?” she wondered. “I can’t believe that. Why?”

Dr. Sandra Lee.
Photo:
Bobby Doherty

Recently, Lee posted a series of questions on the sub-Reddit r/popping to answer precisely this question. One hundred and one people responded. The respondents were men and women (though considerably more of the latter than the former) ranging in age from their teens to their 80s, including one grandmother, named Nana Shirley, who enlisted her daughter-in-law to type out her responses. One was a preschool teacher; another worked as a lawyer; a third was a priest. Some had suffered from severe acne in the past, others had never had a pimple. Many were ashamed and hid their obsession, but others were open and unabashed. Quite a few described chasing their loved ones around the house, trying to pop their zits. (One woman confessed that she had once stopped mid-coitus to pop a pimple on her boyfriend’s shoulder.)

What nearly all of them had in common was a sense that watching a good pop gave them a feeling of deep, vicarious satisfaction. They variously compared that sensation to opening a sticky jar; unwrapping a present; finishing a work of art; pulling up weeds; burping; farting; making it to the bathroom just in time; the TV show Hoarders; the butterflies you feel in your stomach when you experience your first kiss; Sudoku; “seeing a real jerk get what’s coming to him”; a scary movie (“only not scary”); explosions in a Michael Bay film; a roller coaster; a sunset; a shooting star; a natural childbirth (“Gross and messy, but the end result is beautiful in a way”).

This sensation is not limited to popping videos. YouTube also contains surprisingly popular videos of people removing plugs of earwax, shampooing filthy car seats, using wood glue to strip the dust from vinyl records, and power-washing the grime off a metal toolbox. But the intimacy and universality of pimple popping make it an exceptionally cathartic ritual. “Life is hard, so hard,” wrote one popaholic, a 34-year-old woman from Iowa who worked nights and weekends to support her 2-year-old son. “The only thing that makes me feel okay, even for a short period of time, are the videos. I watch them every single night. It’s my only escape right now. So, if you can, please thank Dr. Sandra for me, because I would probably be in a psychiatric hospital if I didn’t have her videos.”

Like pornography, popping videos come in two main genres: soft and hard. Many popaholics report that while they started out only being able to handle soft pops (black- and whiteheads), they now crave something more hard-core: primarily cysts, abscesses, and fatty tumors called lipomas.

After her appointment with Mr. Wilson, Lee had a patient lined up who she hoped would produce a spectacular hard pop. He was an RV salesman named Bill, with a golf-ball-size lump growing atop his leathery forehead. It appeared to be a pilar cyst. A special delicacy among popaholics, pilar cysts are sacs filled with a white toothpaste-y substance made of soggy, dead skin cells. They are not dangerous, but they are unsightly and can occasionally lead to painful infections. Bill said that it had been growing for the past seven years; it had previously been even bigger, but he had “squeezed the fuck out of that thing” until it burst. Then, over time, it grew back.

Lee worked quickly, but when the tip of her scalpel cut into the cyst, two unfortunate things happened more or less simultaneously. First, a thin stream of liquid — what appeared to be a mixture of anesthetic and cyst-juice — jetted out from the incision and hit Lee in the neck. (“It’s like acid, burning a hole in my neck right now,” she joked.) Second, she discovered that inside, the cyst was composed almost entirely of tough, fibrous tissue. For the better part of an hour, she used a pair of scissors and a curette to scrape it out. (When she later sent a tissue sample to a lab, the results revealed that the lump had not been a cyst at all; it was a type of skin cancer.)

Lee looked discouraged. Over the months, she had developed a keen sense of what popaholics will find satisfying. “It’s not rocket science,” she said. “You figure it out because they tell you. They’ll say ‘That was gross, there’s just too much bleeding’ or ‘That was awesome right there, like Silly String!’ ”

Next up on the hard-pop roster was a young woman with a relatively rare condition known as eruptive vellus hair cysts on her back. They, too, refused to pop out cleanly. “You’re interesting, but not greatly satisfying,” Lee told her. “Sorry about that. You don’t take it personally, do you?”

The following day, Lee saw a patient with a benign fatty tumor that adhered stubbornly to the skin and she had to cut it out in pieces. A few hours later, a lipoma walked in, on the back of an exterminator named Ronnie, but the same thing happened; she deemed it a “dud.” The pressure to capture one good, hard pop on film was mounting.

Finally, in walked Geoffrey, a young guy in black athleticwear, with a smaller pilar cyst hidden beneath his short-cropped dark hair.

“Well, we haven’t got any really great pops like this yet, so we’re hoping that you’ll be one,” Lee told him. “Are you going to deliver or not?”

Geoffrey smiled nervously.

Lee readied her tools and instructed Kristie to move the overhead light so her hand didn’t cast a shadow on the cyst. She numbed the area, made a small incision, and then placed two rubber-gloved thumbs on either side of the opening. She pushed: nothing. She pushed harder: nothing. Then she braced herself against the wall and pushed with all her strength …

Pop!

A pale, slippery, oblong object ejected neatly from the skin, like a white edamame bean. Kristie deemed the pop “perfect.” Lee stitched shut the wound, then brought the cyst around, on a bed of gauze, to show to her patient. Then Kristie turned the iPhone around and let him watch the video of it popping out of his skin.

“Huh, I didn’t feel anything,” Geoffrey reflected. “I could tell when it was coming out, though. I just felt, like, a release or something? It’s just like if you’ve ever popped a pimple. I was just like: Whoa, crazy.”

*A version of this article appears in the March 7, 2016 issue of New York Magazine.